•Signs are usually more than symptoms.
RISK FACTORS:
OCULAR FACTORS
• Trauma (Vegetative Matter)
• Chronic corneal inflammation
• Contact lens wear
• Drugs (Corticosteroids)
• Corneal surgery
SYSTEMIC FACTORS
• Diabetes mellitus, HIV positive patients.
SLIT LAMP EXAMINATION:
•An epithelial defect the base of which is filled with soft, creamy exudates surrounded by a grayish area of stromal infiltration.
Specific features:
• Elevated areas.
• Hyphate (branching) ulcers.
• Irregular feathery margins.
• Dry rough texture.
• Satellite lesions.
• Immune ring, endothelial plaque, posterior corneal abscess (rare).
DIAGNOSIS:
• First, we scrape the ulcer from the ulcer edge and base.
• Corneal scraping is both diagnostic and therapeutic as it helps in the debridement and debulking of the organisms and enhances penetration of the anti-fungal drugs.
Send for:
• 10% KOH wet mount.
• Gram’s stain.
• Giemsa stain.
• Calcofluor White stain.
• Blood and chocolate agar.
• Sabouraud dextrose agar.
TREATMENT:
MEDICAL:
• Topical anti-fungals (usually Natamycin suspension) along with cycloplegics and anti-glaucoma drops (Amphotericin B depending on organism).
WHEN DO WE ADD SYSTEMIC ANTI-FUNGALS?
• Large ulcers close to or involving the sclera.
• Very deep ulcers (Occupying posterior 2/3rd of stroma).
Other treatment modalities:
• Intracameral Amphotericin B.
• Intrastromal Voriconazole.
SURGICAL: TPK.
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Image from Rajan Eye Care Hospital